Effects of Cirrhosis and Diagnosis Scenario in Metabolic-Associated Fatty Liver Disease-Related Hepatocellular Carcinoma

Vincent L. Chen, Ming Lun Yeh, Ju Dong Yang, Jennifer Leong, Daniel Q. Huang, Hidenori Toyoda, Yao Li Chen, Jennifer Guy, Mayumi Maeda, Pei Chien Tsai, Chung Feng Huang, Satoshi Yasuda, An K. Le, Hansen Dang, Nasra H. Giama, Hamdi A. Ali, Ning Zhang, Xiaozhong Wang, Dae Won Jun, Cheng Hao TsengYao Chun Hsu, Jee Fu Huang, Chia Yen Dai, Wan Long Chuang, Qiang Zhu, Yock Young Dan, Myron Schwartz, Lewis R. Roberts, Ming Lung Yu, Mindie H. Nguyen

Research output: Contribution to journalArticlepeer-review

Abstract

Metabolic-associated fatty liver disease (MAFLD) is a major cause of liver-related complications, including hepatocellular carcinoma (HCC). While MAFLD-related HCC is known to occur in the absence of cirrhosis, our understanding of MAFLD-related HCC in this setting is limited. Here, we characterize MAFLD-related HCC and the impact of cirrhosis and screening on survival. This was a multicenter, retrospective, cohort study of MAFLD-related HCC. MAFLD was defined based on the presence of race-adjusted overweight, diabetes, or both hypertension and dyslipidemia in the absence of excess alcohol use or other underlying cause of liver disease. The primary outcome of interest was overall survival, and the primary dependent variables were cirrhosis status and prior HCC screening. We used Kaplan-Meier methods to estimate overall survival and Cox proportional hazards models and random forest machine learning to determine factors associated with prognosis. This study included 1,382 patients from 11 centers in the United States and East/Southeast Asia. Cirrhosis was present in 62% of patients, but under half of these patients had undergone imaging within 12 months of HCC diagnosis. Patients with cirrhosis were more likely to have early stage disease but less often received curative therapy. After adjustment, cirrhosis was not associated with prognosis, but the presence of cancer-related symptoms at diagnosis was associated with poorer prognosis. Conclusion: Cirrhosis was not associated with overall survival in this cohort of MAFLD-related HCC, while diagnosis in the presence of symptoms was associated with poorer prognosis. The HCC surveillance rate in patients with MAFLD-related HCC was disappointingly low in a multicenter cohort.

Original languageEnglish (US)
Pages (from-to)122-132
Number of pages11
JournalHepatology Communications
Volume5
Issue number1
DOIs
StatePublished - Sep 24 2020
Externally publishedYes

Bibliographical note

Funding Information:
VLC was supported by the University of Michigan Training in Basic and Translational Digestive Sciences (grant 5T32DK094775), National Natural Science Foundation of China (grant 81770607 to Q.Z.), Agency for Science, Technology, and Research Biomedical Research Council (grant H17/01/a0/003 to Y.Y.D.), National Center Institute (grant P50CA210964 to L.R.R.), and Kaohsiung Medical University Research Center Grant Center for Cancer Research (grant KMU-TC108A04 to M-L.Y.).

Publisher Copyright:
© 2020 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of the American Association for the Study of Liver Diseases.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

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